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PubMed1961

The skin clinic.

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Ambulatory Care Facilities↗
PubMed1992

The postconcussion syndrome and the sequelae of mild head injury.

The postconcussion syndrome refers to a large number of symptoms and signs that may occur alone or in combination following usually mild head injury. The most common complaints are headaches, dizziness, fatigue, irritability, anxiety, insomnia, loss of consciousness and memory, and noise sensitivity. Mild head injury is a major public health concern because the annual incidence is about 150 per 100,000 population, accounting for 75% or more of all head injuries. The postconcussion syndrome has been recognized for at least the last few hundred years and has been the subject of intense controversy for more than 100 years. The Hollywood head injury myth has been an important contributor to persisting skepticism and might be countered by educational efforts and counter-examples from boxing. The organicity of the postconcussion syndrome has now become well documented. Abnormalities following mild head injury have been reported in neuropathologic, neurophysiologic, neuroimaging, and neuropsychologic studies. There are multiple sequelae of mild head injury, including headaches of multiple types, cranial nerve symptoms and signs, psychologic and somatic complaints, and cognitive impairment. Rare sequelae include hematomas, seizures, transient global amnesia, tremor, and dystonia. Neuroimaging and physiologic and psychologic testing should be used judiciously based on the problems of the particular patient rather than in a cookbook fashion. Prognostic studies clearly substantiate the existence of a postconcussion syndrome. Manifestations of the postconcussion syndrome are common, with resolution in most patients by 3 to 6 months after the injury. Persistent symptoms and cognitive deficits are present in a distinct minority of patients for additional months or years. Risk factors for persisting sequelae include age over 40 years; lower educational, intellectual, and socioeconomic level; female gender; alcohol abuse; prior head injury; and multiple trauma. Although a small minority are malingerers, frauds, or have compensation neurosis, most patients have genuine complaints. Contrary to a popular perception, most patients with litigation or compensation claims are not cured by a verdict. Treatment is individualized depending on the specific complaints of the patient. Although a variety of medication and psychologic treatments are currently available, ongoing basic and clinical research of all aspects of mild head injury are crucial to provide more efficacious treatment in the future.

Adult↗
PubMed1992

Some observations on whiplash injuries.

Motor vehicle accidents with a whiplash mechanism of injury are one of the most common causes of neck injuries, with an incidence of perhaps 1 million per year in the United States. Proper adjustment of head restraints can reduce the incidence of neck pain in rear-end collisions by 24%. Persistent neck pain is more common in women by a ratio of 70:30. Whiplash injuries usually result in neck pain owing to myofascial trauma, which has been documented in both animal and human studies. Headaches, reported in 82% of patients acutely, are usually of the muscle contraction type, often associated with greater occipital neuralgia and less often temporomandibular joint syndrome. Occasionally migraine headaches can be precipitated. Dizziness often occurs and can result from vestibular, central, and cervical injury. More than one third of patients acutely complain of paresthesias, which frequently are caused by trigger points and thoracic outlet syndrome and less commonly by cervical radiculopathy. Some studies have indicated that a postconcussion syndrome can develop from a whiplash injury. Interscapular and low back pain are other frequent complaints. Although most patients recover within 3 months after the accident, persistent neck pain and headaches after 2 years are reported by more than 30% and 10% of patients. Risk factors for a less favorable recovery include older age, the presence of interscapular or upper back pain, occipital headache, multiple symptoms or paresthesias at presentation, reduced range of movement of the cervical spine, the presence of an objective neurologic deficit, preexisting degenerative osteoarthritic changes; and the upper middle occupational category. There is only a minimal association of a poor prognosis with the speed or severity of the collision and the extent of vehicle damage. Whiplash injuries result in long-term disability with upward of 6% of patients not returning to work after 1 year. Although litigation is very common and always raises questions of secondary gain in patients with persistent symptoms, most patients are not cured by a verdict. Acute treatment of neck pain consists of ice for 24 hours followed by heat applications, pain pills, NSAIDs, and muscle relaxants. Trigger point injections can be beneficial in both the acute and the persistent phases. Use of cervical collars should probably be kept to a minimum during the first 2 to 3 weeks after the injury and then avoided. Early passive mobilization and range of motion exercises may accelerate recovery. Physical therapy and transcutaneous nerve stimulators may be helpful in reducing pain and improving movement.(ABSTRACT TRUNCATED AT 400 WORDS)

Diagnosis, Differential↗
PubMed1992

Illness as a lifestyle. The role of somatization in medical practice.

Persons with psychological problems who translate their distress into somatic symptoms (somatize) are frequent users of medical care. These patients often have underlying depression, anxiety, obsessive--compulsive symptoms, or personality disorders. Descriptions of the somatizing syndromes are provided in association with recommendations as how to recognize and manage the patient with somatization.

Conversion Disorder↗
PubMed2004

Detection of neurocognitive feigning: development of a multi-strategy assessment.

Neuropsychological assessments can be completely invalidated by persons successfully feigning neurocognitive impairment. The current investigation examines via a research measure, the Test of Cognitive Abilities (TOCA), the usefulness of multiple detection strategies for the classification of neurocognitive feigning. Using a simulation design with a manipulation check and both positive and negative incentives, two groups of simulators (Cautioned and NonCautioned) were compared with brain-injured patients and nonimpaired controls. Among detection strategies, Magnitude of Error (hit rate=.94) was highly effective, while Floor Effect (hit rate=.80) and Reaction Time (hit rate=.85) were moderately effective. When presented with complex strategies, the cautioning of simulators did not improve their performances.

Brain Injuries↗
PubMed2003

["Post-traumatic stress disorder"--historical aspects of a "modern" psychiatric illness in the German language areas].

Although posttraumatic stress disorder has only recently been admitted into the international classification systems, psychological reactions to traumatic incidents have been frequently described for well over a hundred years. This article provides an overview of mental reactions to a trauma in different historical situations. It discusses the "railway spine injuries" of the 19th century, victims of accidents in which third party liability could be established, and the psychological consequences of the catastrophes that characterised the 20th century: World War I, the rule of National Socialism, World War II, the expulsion and persecution of political opponents in the former GDR. The analysis suggests that the different psychological reactions do not describe an identical disorder. It seems that reactions to injuries are mainly influenced by the historical and social background.

Combat Disorders↗
PubMed1992

A simplified method for determination of specific DNA or RNA copy number using quantitative PCR and an automatic DNA sequencer.

Quantification of specific RNA or DNA molecules that are present in minute amounts in biological samples has previously been performed using PCR in the presence of an internal standard. We have adapted this concept by introducing several modifications that facilitate the quantification of the products and obviate the need for radioisotopes. After amplification, individual products are separated on sequencing gels and directly quantified using a fluorescent automated DNA sequencer. We describe two applications of this approach: the quantitation of minute amounts of bcr-abl hybrid mRNA from malignant cells and the determination of gene copy number in cells stably transfected with a plasmid bearing a chloramphenicol acetyltransferase gene.

Automation↗

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